2 - Anxiety Disorders

Question 1

Anxiety disorder definition and 4 examples

Answer 1

Excessive or pathologial levels of Anxiety that interfere with function

Panic disorders, Social Phobia, GAD, Specific Phobia

Question 2

3 Familial or Developments Factors of Anxiety Disorders

Answer 2

• Genetic vulnerability (30-50% in monozygotic twins)
• Developmental Features (behavioral inhibition)
• Life Experiences/Stressors (early trauma)

Question 3

Two brain things thought to be connected to anxiety

Answer 3

Limbic Hypersensitivity

Reduced Modulation from Cortex

Question 4

Major site of action for antianxiety drugs

Answer 4

Limbic System

Question 5

“Resetting the Inhibition Tone”

What is the goal and how to achieve it (three ways and Tx for each)?

Answer 5

Goal = Decrease Limbic activity

• Strengthen Prefrontal Cortex (CBT)
• Increase Serotonin Levels in the circuits (AntiD’s)
• Increase GABA inhibition in the amygdala and HC (Benzo’s)

Question 6

Psychological Treatment for Anxiety disorders

Answer 6

CBT

MABT (Mindfulness - Acceptance - Based Therapy)

Question 7

NE effects

Answer 7

Alertness and energy

Question 8

DA effects

Answer 8

Attention, motivation, pleasure and reward

Question 9

Serotonin effects

Answer 9

Obsessions and compulsions

Question 10

Drug class that works on NE, DA, 5HT

Answer 10

MAO inhibitors

Question 11

Panic attack criteria DSM5 (3)

Answer 11

Develop sudden fear/discomfort

10min peak

at least 4 symptoms for full attack

Question 12

DSM5 for Panic Disorder (3)

Answer 12

1. Recurrent, unexpected panic attacks
2. Attack followed by at least 1 month of
   
   1. Concern over future attacks
   2. Worry about consequences
   3. Significant behavioral change
3. Not due to ORGANIC cause or OTHER psychiatric disorder

Question 13

Panic disorder epidemiology, associated with…

Answer 13

affects 1-2% (attacks = 5-8%)

associated with agoraphobia, depression, etoh abuse

Question 14

Panic disorder usually presents with…

Answer 14

a physical focus

Question 15

Panic disorder treatments (Psych and Pharm)

Answer 15

Psych = CBT

Pharm = SSRI, Tricyclic, Benzo’s, MAOI’s

Question 16

Which SSRI’s are effective in PD

Answer 16

All of them (sertraline, paroxetine)

Question 17

SSRI dose for PD

Answer 17

LOW to start

Fluox and Parox = 5mg, Sert = 25mg

Question 18

Comorbidity for PD (5)

Answer 18

Depression

Agoraphobia

Other anxiety disorders

EtOH abuse

Personality disorders

Question 19

Social AD 7 criteria

Answer 19

1. Persistent fear of one or more social situations
2. Exposure provokes fear
3. Fear is excessive
4. Avoidance or endurance of feared situations
5. 6 month persistence
6. Significantly interferes with life
7. NOT due to another condition

Question 20

Most common fears

Answer 20

Glossophobia

Meeting Strangers

Question 21

SAD prevalence

Answer 21

7. 9% 1 year
8. 3% Lifetime

Question 22

SAD male to female ratio

Answer 22

1 : 2.5

Question 23

SAD mean age of onset

Answer 23

11-15 years

Question 24

Social phobia morbidity

• Financial
• Education
• Socioeconomic
• Marital

Answer 24

22.3% were on welfare

50% No high school

70% were in lowest SE quartiles

50% were single or divorced

Question 25

Generalized Anxiety Disorder DSM5 (4 criteria)

Answer 25

* **Excessive anxiety or worry** about a number of events or activities for **6 months** * Patient finds it **difficult to control** the worry * **Three** of the following * *Restlessness* * *easily fatigued* * *Difficulty concentrating* * *Irritability* * *Muscle tension* * *Sleep disturbance* * Clinically significant **impairment** of function

Question 26

GAD Prevalence (Men, Women, Total)

Answer 26

Men - 3.6 Women - 6.6 Total - 5.7

Question 27

GAD age of onset (Early vs. Late)

Answer 27

_Early_ = Before 20, Female-Dominant _Late_ = Adult onset, Male and female equal, Usually precipitated by Stressful event

Question 28

Useful Pharm for GAD (3) Other Tx?

Answer 28

* Benzo * Azospirones (Buspirone) * AD's (SSRI) Psychotherapies also useful

Question 29

OCD Dx (3)

Answer 29

* Characterized by obsessions or compulsions * They cause significant disability or discomfort * One or more hour per day

Question 30

Most common OCD obsessions

Answer 30

Contamination Fear of harm

Question 31

Characteristics of Compulsions in OCD (3)

Answer 31

Repetitive behaviors Usually done to neutralize the anxiety induced by the obsession Most pts acknowledge the futility

Question 32

OCD Epid.

Answer 32

2-3% Early onset, severe in males

Question 33

OCD pathophys

Answer 33

Basal ganglia less active -\> less dampening/control

Question 34

Which circuit in OCD

Answer 34

Fronto-striato-thalamo-frontal

Question 35

OCD Tx

Answer 35

SSRIs are most effective Start at higher dose and longer duration Always combine with CBT

Question 36

Acute stress and PTSD criteria (6)

Answer 36

* Severe trauma * 1 month of Sx * Re-experiencing of trauma (1 or more) * Avoidance (1 or more) * Negative alterations in cognition and mood (2 or more) * Sx of disturbed arousal (2 or more) Specify 1- with dissociative Sx or 2- with delayed expression

Question 37

Define trauma

Answer 37

_Life threatening (or potentially) situation_ Most critical elements = sense of horror and helplessness Inherent subjective nature to the experience

Question 38

Incidence of PTSD

Answer 38

3.5% of all US adults

Question 39

\_\_\_% of PTSD are considered severe

Answer 39

36.6%

Question 40

Risk factors for developing PTSD

Answer 40

Type of trauma Gender Age Genetic vulnerability

Question 41

Highest populations with PTSD

Answer 41

Abused kids \> Battered women \> Rape victims \> Military \> Firefighters \> Police

Question 42

PTSD Tx (Pharm and other)

Answer 42

**SSRI** improve half of patients, **Anticonvulsants** may also be useful Combo of **meds and** **Therapy**